Investigation of the diagnostic importance and accuracy of CT in the chest compared to the RT-PCR test for suspected COVID-19 patients in Jordan.

This article aims to synthesize the existing literature on the implementation of public policies to incentivize the development of treatments for rare diseases, (diseases with very low prevalence and therefore with low commercial interest) otherwise known as orphan drugs. The implementation of these incentives in the United States (US), Japan, and in the European Union (EU) seems to be related to a substantial increase in treatments for these diseases, and has influenced the way the pharmaceutical research & development (R&D) system operates beyond this policy area. Despite the success of the Orphan Drug model, the academic literature also highlights the negative implications that these public policies have on affordability and access to orphan drugs, as well as on the prioritization of certain disease rare areas over others. The synthesis focuses mostly on the United States' Orphan Drug Act (ODA) as a model for subsequent policies in other regions and countries. It starts with a historical overview of the creation of the term "rare diseases", continues with a summary of the evidence available on the US ODA's positive and negative impacts, and provides a summary of the different proposals to reform these incentives in light of the negative outcomes described. Finally, it describes some key aspects of the Japanese and European policies, as well as some of the challenges captured in the literature related to their impact in Low- and Middle-Income Countries (LMICs).

Mammographic Breast Density Profile of Jordanian Women With Normal and Breast Cancer Findings.

PURPOSE: To document the mammographic breast density (MBD) distribution of Jordanian women and the relationship with MBD with age. Correlation between breast cancer diagnosis and density was also explored. METHODS: A retrospective review of 660 screening mammograms from King Abdullah University Hospital was conducted. Mammograms were classified into 2 groups: normal (return to routine screening) and breast cancer and rated using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) 5th edition for MBD. The association between MBD and age was assessed by descriptive analyses and Kruskal-Wallis test. To compare between normal and breast cancer groups, chi-square post hoc tests with Bonferroni adjustment was used. RESULTS: Groups consisted of 73.9% (n = 488) normal group and 26.1% (n = 172) breast cancer group. A significant inverse relationship was demonstrated between age and MBD among the normal (r = -.319, P < .01) and breast cancer group (r = -.569, P < .01). In total, 69% (n = 336) of women in the normal group and 71% (n = 122) in the breast cancer group and 79.1% (n = 159) of the normal group and 100% (n = 48) of the breast cancer group aged 40 to 49 years reported high MBD (ACR BI-RADS c or d). CONCLUSIONS: Most of women in both the normal and breast cancer groups evidenced increased MBD. Increased MBD was inversely proportional to age. As MBD has a known link to increased breast cancer risk and the decreased sensitivity of mammography and it is vital that future screening guidelines for Jordanian women consider the unique breast density distribution of this population.

The implications of increased mammographic breast density for breast screening in Jordan.

INTRODUCTION: Mammographic breast density is associated with a four to six times increased risk for breast cancer. Mammographic breast density varies by ethnicity, geographical region and age. The aim of this study was to document for the first time the mammographic breast density of Jordanian women and to explore its relationship with age. METHODS: Mammograms completed at King Abdullah University Hospital (Irbid, Jordan) between January 2016 and August 2018 were retrospectively reviewed and classified for breast density using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS). Descriptive analyses and Kurskal-Wallis test were used to examine the association between age and mammographic breast density. RESULTS: A total of 659 mammograms were reviewed. A significant inverse relationship was observed between age and breast density (P < 0.001). In women aged 40-49 years, 83.2% had dense breasts (ACR BI-RADS (c) and (d)). This percentage decreased to 59.8% of women aged 50-59 years; 38.4% of women in their 60s and 37.9% of women aged 70 years or older (ACR BI-RADS (c) only). CONCLUSION: The mammographic breast density of Jordanian women has been shown to be high across all age groups. Increased mammographic breast density is associated with increased breast cancer risk and renders mammography a less effective technique for the early detection of breast cancer. Breast cancer screening of Jordanian women should be individualised to develop screening protocols and include additional adjunct imaging to best manage women at high risk.

Diagnostic reference levels for paediatric CT in Jordan.

This study aimed to investigate the current status of Diagnostic Reference Levels (DRLs) in paediatric CT across Jordan. The dose data for four main CT examinations (brain, chest, abdominopelvic, and chest, abdomen and pelvis (CAP)) in hospitals and imaging centres (n = 4) were measured. The volume CT dose index (CTDIvol) and Dose Length Product (DLP) values were compared within the different hospitals and age groups (<1 year, 1-4 years, 5-10 years and 11-18 years). DRLs in Jordan were compared to international DRLs. The paediatric population consisted of 1818 children; 61.4% of them were male. There were significant variations between the DRLs for each CT scanner with an up to four-fold difference in dose between hospitals. There were apparent significant differences between Jordan and other countries with the DLPs in Jordan being relatively high. However, for CTDIvol, the values in Jordan were close to those of other countries. This study confirmed variations in the CTDIvol and DLP values of paediatric CT scans in Jordan. These variations were attributed to the different protocols and equipment used. There is a need to optimise paediatric CT examinations doses in Jordan.

Establishment of diagnostic reference levels in cardiac computed tomography.

The aim of this study was to determine diagnostic reference levels (DRLs) for cardiac computed tomography (CCT) in Jordan. Volume computed tomography dose index (CTDIvol ) and dose-length product (DLP) were collected from 228 CCTs performed at seven Jordanian hospitals specialized in cardiac CT. DRLs for cardiac CT were defined at the 75th percentile of CTDIvol and DLP. CTDIvol and DLP were collected from 30 successive cardiac CT in each center except for one center (18 scans). The 75th percentile of the CTDIvol and the DLP of the centers calculated from mixed retrospective and prospective gated modes were 47.74 milligray (mGy) and 1035 mGy/cm, respectively. This study demonstrated wide dose variations among the surveyed hospitals for cardiac CT scans; there was a 5.1-fold difference between the highest and lowest median DLP with a range of 223.2-1146.7 mGy/cm. Differences were associated with variations in the mAs and kVp. This study confirmed large variability in CTDIvol and DLP for cardiac CT scans; variation was associated with acquisition protocols and highlights the need for dose optimization. DRLs are proposed for CCT; there remains substantial potential for optimization of cardiac CT examinations for adults in Jordan.

Knowledge and practice of computed tomography exposure parameters amongst radiographers in Jordan.

OBJECTIVE: To investigate the knowledge and practice of computed tomography (CT) radiographers working in Jordan. MATERIALS AND METHODS: This Institutional Review Board (IRB) approved study disseminated a questionnaire via social media and recruited 54 Jordanian CT radiographers. The questionnaire comprised 36 questions divided into four sections: demographics; an evaluation of knowledge regarding CT exposure; modifications to CT exposure for paediatric patients; dose units and diagnostic reference levels (DRLs). Descriptive and inferential statistics including Chi-square tests, Mann-Whitney U tests, independent samples t-tests and Kruskal-Wallis H tests were employed. Statistical significance was considered below p < 0.05. RESULTS: The 54 participants had various qualifications, with the majority holding a Bachelor's degree (n = 35, 64.8%) and the rest holding a Diploma (n = 19, 35.2%). In order to pass the questionnaire, participants needed to score 13 correct answers. The overall number of radiographers who correctly passed the questionnaire was 48 (88.9%). None of the participants correctly stated all the DRL values for chest, abdomen and brain CT. However, four out of 54 respondents (7.4%) knew the chest DRL value, three (5.6%) participants correctly estimated the abdominal DRL value but only two (3.7%) knew the DRL for the brain. CONCLUSION: Good general knowledge was found amongst radiographers regarding the relationship of each exposure parameter to the image quality and patient dose. However, there was poor knowledge of diagnostic reference levels and the order of the organ radiation sensitivity. The need for CT radiographers to undertake further education that focuses on radiation exposure in CT is highlighted.

Compliance With Radiation Protection Practices Among Radiologists.

BACKGROUND: Radiologists are at higher risk of adverse health effects due to their occupational radiation exposure; therefore, applying protection techniques is imperative. Studies on radiologists' compliance in this regard are scarce. We aimed to assess compliance with radiation safety practices among radiologists. METHODS: Questionnaires were distributed to radiologists in tertiary hospitals. The questionnaire was designed to assess compliance in three domains: using personal protective devices, using exposure-reduction techniques during fluoroscopic exposures, and using personal dose-monitoring devices. Descriptive analysis of the compliance was performed. RESULTS: Sixty-two radiologists were included in the analysis. Use of leaded aprons and thyroid shields was commonplace, whereas only 3.2% ever use leaded eyeglasses. About half of the radiologists always considered reducing the time of exposure and avoided exposure by the primary beam, and the other half did that sometimes. Most of the radiologists (66.1%) always complied with reducing the number of unnecessary exposures, and the rest only complied sometimes. Most of the radiologists (93.5%) always used single personal dose-monitoring devices, most commonly at the neck level over the collar. There was no difference in compliance between different sexes, position descriptions, hospital types, hospital sizes, or years of experience. CONCLUSION: Future compliance improvement strategies for radiologists should focus on use of thyroid shields and leaded eyeglasses and use of exposure-reduction techniques during fluoroscopic operations.

Medical Radiation Knowledge among Patients in Local Hospitals.

OBJECTIVE: Evaluation of patient knowledge regarding radiation and its associated risks can identify knowledge gaps, providing an opportunity to increase patient awareness and understanding of medical radiation. The aims of this study were to evaluate the awareness level of patients regarding medical radiation types used in medical diagnostic imaging and to correlate them with the availability of radiation information provided upon examination. METHODS: A qualified radiographer distributed a multiple choice questionnaire in four major Jordanian hospitals, including three governmental hospitals and one university hospital. The questionnaire included demographic and radiation awareness sections. The sample included 400 patients who were undergoing routine x-ray imaging, computed tomography, fluoroscopy, magnetic resonance imaging, ultrasound, or nuclear medicine. RESULTS: Less than 50% of the participants had received information on radiation awareness upon examination. The average scores of the radiation awareness questionnaire ranged from 56% to 70%. There was a significant correlation (r = 1.00, P < .05) between those who were provided radiation information upon examination and the radiation awareness questions score. CONCLUSIONS: Most of the patients did not receive the radiation awareness information upon examination, which reflected the low level of general radiation knowledge in most hospitals. Patient education and awareness should be improved to reduce unnecessary exposure from medical imaging examinations.

Work-related Stress, Musculoskeletal Disorder Complaints, and Stress Symptoms among Radiographers in the Northern Part of Jordan.

OBJECTIVE: The aims of this study were to report the variation in work-related stressor (WRS) and musculoskeletal disorder (MSD) complaints across three major hospitals in the northern part of Jordan and to examine the correlations between stressors, MSD complaints, and stress symptoms using a questionnaire. METHODS: A qualified radiographer distributed a questionnaire in the radiology department at three hospitals, including a governmental public hospital (GH), a university educational hospital (UH), and a private hospital (PH). The questionnaire included demographic, WRS, management and responsibility stressors, stress symptoms, stress relievers, and MSD complaints sections. A total of 74 radiographers (GH = 28, UH = 29, PH = 17) agreed to participate after signing a consent form. RESULTS: The average age ranged from 30.8 ± 3.3 to 33.6 ± 1.4 (P = .6), and the average experience ranged from 6.2 ± 2.5 to 8 ± 1.2 years (P = .7) in the hospitals. The number of men was higher than women only in the UH (ratio = 2.6). The number of diploma degree holders was higher than the number of bachelor's degree holders only in the GH (ratio = 3). Stress symptoms such as depression and MSD complaints such as low back pain in the GH were significantly higher than the other hospitals. There was a significant correlation (Spearman correlation coefficient = 0.61, P = .04) between WRS and MSD complaints. CONCLUSION: The GH had more MSD complaints and stress symptoms than the other hospitals. WRSs were correlated significantly with MSD complaints. Encouraging the radiographers to attend work stress management sessions may help in reducing the level of stress.